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Conquering food addiction

By Jennifer LaRue Huget
Special to The Washington Post
Tuesday, January 18, 2011; 5:34 PM

Sitting across a Starbucks table from Michael Prager a few weeks ago, I'd never have guessed that he once weighed 365 pounds. Or that he's an addict.

I met with Prager, a 53-year-old author, journalist, blogger and stay-at-home dad who lives in Arlington, Mass., to talk about his self-published book, "Fat Boy, Thin Man" (2010). It's a clear-headed exposition of a life in which 12-inch roast beef Subway sandwiches with onions and mayonnaise once played a central and controlling role.

Prager is thin, even angular, nowadays. But his 160-pound weight loss some 20 years ago came only after he accepted a discomfiting idea: He was addicted to food.

The notion of food addiction remains controversial, but there's growing belief that it's a real phenomenon, a stance that's increasingly supported by science. Recent research found that people with a family history of alcoholism had increased risk of obesity, suggesting that both conditions might be driven by the same tendency toward addictive behavior. In fact, some experts think food addiction might be one of the prime causes of America's obesity epidemic, especially as potentially addictive ingredients such as fat, sugar and salt have played a larger role in our nation's diet.

A fight for control

When Prager was in his early 30s, he reluctantly came to understand that both his obesity and his inability to get along with other people derived from the same root cause: his lifelong obsession with cramming food into his maw. As with other addicts, he explains, his emotional development stalled the moment he became addicted; for him, that was at age 12, in the midst of a troubled childhood.

Prager's book is peppered with accounts of unsettling behaviors: leaving a family dinner early to ensure he'd get to the McDonald's drive-through before it closed, loading his car with enough sub sandwiches so he would, he writes, "have something for the ride home without running out once I'd got there." Some of those sound scarily familiar to me.

Rather than consign the rest of his life to his addiction, the adult Prager sought treatment at the urging of others. And, after decades of gaining and losing the same 100 pounds, he finally shed his extra weight. It seems the pounds might be gone for good: The 5-foot-10 Prager has weighed about 210 pounds for the past 20 years.

But maintaining that weight loss requires constant vigilance and discipline. When he measures his morning serving of yogurt, if a bit of it lands on his finger he must rinse it right off. Allowing himself to lick it off, he knows, would be the first step down a slippery slope leading to reckless consumption; he has to control food, or it will again control him.

Hijacking the brain

Food addiction does not have an entry in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association's bible of accepted psychological diagnoses. Inclusion in the DSM lends legitimacy to conditions and paves the way for insurance to cover treatment.

But many psychologists recognize and treat food addiction anyway. Marilyn Mertzl, a psychoanalyst practicing in Kansas City, Mo., says, "Addiction to food operates on the same neurobiological highway as addiction to drugs, sex, gambling or alcohol."

As with any addiction, Mertzl says, "the source of all pleasure has become the source of all pain."

"With food addicts, they eat all day, and they eat all night. The turnoff valve is broken. They don't have the [physical] signal of fullness. Usually by the time they come to me, they've tried a variety of unsuccessful interventions."

Mertzl works with patients to identify and address the causes of their compulsion. For many, those include childhood experience of sexual abuse or parental controls over food, such as using it as a reward or requiring children to clean their plates. Mertzl also advises on such practical tasks as learning to eat more slowly and to eat while sitting down, with a nicely set place at the table, instead of gorging in front of an open fridge.

Ashley Gearhardt, a clinical psychology doctoral student who studies food addiction at the Yale Rudd Center for Food Policy and Obesity, says animal research has found that certain foods ¿ often those containing lots of sugar, salt or fat ¿ can trigger the same brain receptors that are triggered by addictive drugs. It appears that for people at risk of food addiction, "some foods may have the ability to hijack the brain" the way other addictive substances can, she says.

Ashley Gearhardt, a clinical psychology doctoral student who studies food addiction at the Yale Rudd Center for Food Policy and Obesity, says animal research has found that certain foods ¿ often those containing lots of sugar, salt or fat ¿ can trigger the same brain receptors that are triggered by addictive drugs. It appears that for people at risk of food addiction, "some foods may have the ability to hijack the brain" the way other addictive substances can, she says.

Gearhardt says that support programs, particularly 12-step ones patterned after Alcoholics Anonymous, and cognitive behavioral therapy can help people cope with food addiction. For Prager, overcoming food addiction has required developing "a clear plan of eating" with a nutritionist and seeking support from others. You can't just quit eating, he notes, but you can quit eating the foods you can't handle. For him, those include popcorn, peanuts, bagels with cream cheese and even sugarless gum.

Until I talked to Prager, I was among the many skeptics who viewed "food addiction" as a cop-out, a means of abandoning personal responsibility for what you put in your mouth. But Prager is quite clear on that point. "When I find out I have an illness, I take on responsibility to make it better," he says. "I have no respect for people who use [their addiction] as a crutch."

He adds, "Nobody ever held me down and put a doughnut in my mouth."

Pinpointing addiction

Consult your doctor if you think you might be addicted to food, who might refer you to a specialist. A physician or therapist might ask questions to help pin down signs of substance abuse.

Michael Prager outlines those questions in his book. Here's a sample:

- Do you increase the amount you eat over time to achieve the same effect?

- Does stopping overeating cause physical symptoms?

- Do you eat more food, and for a longer time, than you'd planned to at first? Have you tried unsuccessfully to cut down on or control your eating? Do you spend lots of time and effort to obtain food and recover from overeating? Do you sacrifice other activities to accommodate your overeating? And continue to overeat, even though you know the consequences are likely to grow worse?

There many are support groups and services, including 12-step programs patterned after Alcoholics Anonymous, for those who might suffer from food addiction. Here are a few:

- Overeaters Anonymous, 505-891-2664

- Food Addicts Anonymous, 561-967-3871

- Food Addicts in Recovery Anonymous, 781-932-6300

- American Psychological Association

For nutrition news, visit the Checkup blog, follow @jhuget on Twitter and subscribe to the Lean & Fit newsletter by going to The Post's Wellness page.

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